Clinical milestones predict symptom remission over 6-month and choice of treatment of patients with major depressive disorder (MDD).
BACKGROUND
It is uncertain as to what short-term outcomes predict long-term treatment compliance and outcomes in patients with MDD.


OBJECTIVE
To determine what treatment milestones predict symptom remission with long-term treatment with antidepressant medication.


METHODS
Pooled analysis of four randomised, double-blind, active comparator, 6-month trials in MDD.


RESULTS
Patients received double-blind treatment with escitalopram (N=699) or a comparator (citalopram, duloxetine, or paroxetine) (N=699). Onset of effect at week 2 was correlated with response at week 8, and response at week 8 with completion of 6-month treatment. Week 8 response was associated with a greater probability of achieving later remission. Week 24 remission (MADRS>or=10) was significantly (p<0.01) higher for patients treated with escitalopram (70.7%) than for the pooled comparators (64.7%). Week 24 complete remission (MADRS<or=5) was significantly (p<0.01) higher for escitalopram (51.7%) than for the pooled comparators (45.6%). Fewer patients discontinued treatment with escitalopram (15.9%) than with the pooled comparators (23.9%) (p<0.001).


CONCLUSIONS
A higher probability of achieving remission is associated with responding after 8 weeks and with completing 6 months of treatment.
Wade
A G
AG
CPS Clinical Research Centre, Glasgow, United Kingdom. alan@edgehill.demon.co.uk
Schlaepfer
T E
TE
Andersen
H F
HF
Kilts
C D
CD
D000328:Adult; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D000068736:Duloxetine Hydrochloride; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000627:therapeutic use*; D010349:Patient Compliance / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012074:Remission Induction / Q000379:methods; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D013876:Thiophenes; D015283:Citalopram; D017374:Paroxetine; D000068736:Duloxetine Hydrochloride